NPIMap

Organization Active NPI

Kencrest Services

  • Intellectual Disabilities Intermediate Care Facility
  • Philadelphia, PA
National Provider Identifier
1033244454
Registry record updated Jul 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
517910 Issued in PA
Legal business name
KENCREST SERVICES
Practice address
1 Waterman Ave
Philadelphia, PA 19118-3625
Phone
(610) 825-9360
Fax
(610) 825-4127
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tonia McNeal
Title
Cfo
Phone
(610) 825-9360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 517910 PA Primary

Addresses

Primary practice location

1 Waterman Ave
Philadelphia, PA 19118-3625

Mailing address

960A Harvest Dr
Suite 100
Blue Bell, PA 19422-1900
Phone (610) 825-9360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 39G375

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
KENCREST SERVICES - WATERMAN
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 6, 2005
Last certification
Apr 23, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
1 Waterman Ave
Philadelphia, PA 19118

National Provider Directory

National Provider Directory
Tax ID family
Kencrest Services13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1033244454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960A HARVEST DR",
            "address_2": "SUITE 100",
            "city": "BLUE BELL",
            "state": "PA",
            "postal_code": "194221900",
            "telephone_number": "610-825-9360",
            "fax_number": "610-825-2741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WATERMAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191183625",
            "telephone_number": "610-825-9360",
            "fax_number": "610-825-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENCREST SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "MCNEAL",
        "authorized_official_first_name": "TONIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "610-825-9360"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "PA",
            "license": "517910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.